Sickle Cell Disease and Stroke
Pediatric EM Morsels
APRIL 7, 2023
Unfortunately, it can cause so many other complications – Sepsis , acute chest syndrome , and hepatopathy.
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SGEM Xtra: Are tPA Stroke Trials Really Fragile?
The Skeptics' Guide to EM
AUGUST 20, 2022
Fragility Index Meta-Analysis of Randomized Controlled Trials Shows Highly Robust Evidential Strength for Benefit of The post SGEM Xtra: Are tPA Stroke Trials Really Fragile? I knew about Jeff from his multiple publications in the stroke literature. first appeared on The Skeptics Guide to Emergency Medicine. This is an SGEM Xtra.
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SGEM#330: Should You Be Going Mobile to Treat Acute Ischemic Stroke?
The Skeptics' Guide to EM
MAY 15, 2021
Daniel Schwerin is employed with Prisma Health-Upstate as a clinical assistant professor, emergency medicine GME director for emergency medical services and medical director for several local EMS agencies and has lectured on prehospital stroke management. Background: We have discussed stroke so many times on the SGEM.
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BCVI | Head CT - Antithrombotics | Heat Stroke | No Antibiotic Peds CAP | Surviving Quarantine
JournalFeed
APRIL 25, 2020
Here is the JournalFeed Podcast for the week of April 20-24, 2020. We cover blunt cerebrovascular injury, head CT in patients on antithrombotic agents, cooling heat stroke victims, avoiding antibiotics in pediatric pneumonia, and surviving quarantine. Special thanks to Lara Fesdekjian for writing theme music!
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Stroke Review | MSK Guidelines | Cirrhosis UGIB Antibiotics | Early Norepinephrine | Taping an ETT
JournalFeed
SEPTEMBER 5, 2020
We cover a review of acute ischemic stroke, ACP/AAFP musculoskeletal pain guidelines, antibiotics for cirrhosis with upper GI bleed, early norepinephrine for septic shock, and the best way to tape an ETT so it won’t come out. It’s the JournalFeed Podcast for the week of Aug. 31 - Sept.
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Prehospital identification of acute ischaemic stroke with large vessel occlusion: a retrospective study from western Norway
Emergency Medicine Journal
MARCH 21, 2024
Background In 2019, the emergency medical services (EMS) covering the western Norway Regional Health Authority area implemented its version of the prehospital clinical criteria G-FAST (Gaze deviation, Facial palsy, Arm weakness, Visual loss, Speech disturbance) to detect acute ischaemic stroke (AIS) with large vessel occlusion (LVO).
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2023 Critical Care Year in Review (Part 1)
PulmCCM
DECEMBER 11, 2023
Simvastatin seemed highly likely to have reduced ventilator-days and mortality in critically ill patients with Covid-19 between 2020 and 2022, compared to placebo ( REMAP-CAP ) Paxlovid seems to continue to improve outcomes from Omicron-era Covid-19 in patients at increased risk for progression to severe disease, but not in patients at average risk.
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Glasgow Coma Scale in Children
Pediatric EM Morsels
JULY 21, 2023
Orso 2020] One pediatric study in this systematic review, and the intubated patients had worse outcome than non-intubated Early airway protection = lower rates of complications (in TRAUMA), but this is not always true with medical patients. 2020 Dec 10;28(1):116. BMJ Open 2021; 11: e053619. Scand J Trauma Resusc Emerg Med. 107.498345.
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Anticoagulant Selection Is Cornerstone of Pulmonary Embolism Treatment
ACEP Now
MARCH 11, 2025
2-4 A study in Annals of Emergency Medicine of almost 300,000 patients hospitalized with acute PE between 2011-2020 found that the use of UFH increased from 41.9 Trends in initial anticoagulation among US patients hospitalized with acute pulmonary embolism 2011-2020. Stubblefield WB, Helderman R, Strokes N, et al. percent to 56.3
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Peds Surviving Sepsis | Mortality After Naloxone | Spontaneous PTX - Tube or Not | Opioids and Peds Sedation Risk | Missing Stroke with HINTS
JournalFeed
APRIL 4, 2020
Here is the JournalFeed Podcast for the week of March 30- April 3, 2020. We cover Pediatric Surviving Sepsis; mortality risk after out-of-hospital naloxone; spontaneous pneumothorax - tube or no tube; opioids prior to pediatric sedation; and HINTS by emergency physicians and stroke risk.
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emDOCs Videocast: EBM Update – IV BP Meds in NV Emergencies
EMDocs
SEPTEMBER 8, 2024
Design: Systematic review of literature databases from inception up to August 2020 seeking to identify superiority (efficacy and safety) with one anti-hypertensive agent over another in patients presenting with acute neurovascular emergencies. Authors used PRISMA guidelines. Exclusion criteria: BP control for non-neurologic disease (e.g.,
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SGEM#290: Neurologist Led Stroke Teams – Working 9 to 5
The Skeptics' Guide to EM
APRIL 25, 2020
Date: April 21st, 2020 Reference: Juergens et al. Effectiveness of emergency physician determinations of the need for thrombolytic therapy in acute stroke. Date: April 21st, 2020 Reference: Juergens et al. Effectiveness of emergency physician determinations of the need for thrombolytic therapy in acute stroke.
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SGEM#303: Two Can Make It – Less likely to have another stroke but more likely to have a bleed (THALES Trial)
The Skeptics' Guide to EM
OCTOBER 3, 2020
Date: October 2nd, 2020 Guest Skeptic: Dr.Barbra Backus is an emergency physician at the Emergency Department of the Erasmus University Medical Center in Rotterdam, the Netherlands. Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA. Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA.
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The PROPHY-VAP Trial: Ceftriaxone to Prevent VAP in Patients with Acute Brain Injury
RebelEM
FEBRUARY 29, 2024
3, 6 Among patients with stroke or traumatic brain injury (TBI), the risk may be as high as 28%-76% and 23%-60%, respectively. Neurocrit Care 2020 , 32 (1), 272-285. Chest 2020 , 158 (6), 2292-2303. Post-stroke infection: a systematic review and meta-analysis. 4, 8 Paper: Dahyot-Fizelier, C., Banzato, E.; Wiegers, E.
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The Approach to Neuromuscular Weakness
Taming the SRU
SEPTEMBER 12, 2024
Neuromuscular (NM) weakness can have various causes, ranging from common and relatively easy to diagnose conditions (such as strokes and trauma) to less common and more difficult to diagnose ones (such as vascular pathologies, infections, autoimmune diseases, and neoplasms). Stroke: causes and clinical features. & Werring, D.
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Regular Wide Complex Tachycarida with poor LV function and hypotension. Duration unknown. How to manage?
Dr. Smith's ECG Blog
JULY 5, 2024
But the duration of symptoms was prolonged and so to avoid the risk of stroke, AV nodal blockade (rate control) was preferred. We want to avoid a stroke. They chose to give adenosine, and this is what happened: Adenosine to verify flutter: flutter waves made obvious Not actually from this case. What AV nodal blocker should we give?
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IVC Distensibility Index vs Collapsibility Index: Using the Correct Index
RebelEM
FEBRUARY 24, 2025
Of course, there are other methods of assessing fluid tolerance : Capillary refill evaluation, passive leg raise, central venous pressure measurement, pulmonary artery wedge pressures, stroke volume variation, pulse pressure variation, etc. Nov 2020; PMID: 33140173 Hanson J, et al. Effects of capillary refill time-vs. Malar J.
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A Beginner’s Guide to Vasoactive Drug use in Children with Septic Shock
Don't Forget the Bubbles
NOVEMBER 27, 2023
The amount of blood that comes from the heart with each contraction is the stroke volume (SV). The stroke volume is the difference between how full it is at the start and how full it is after a contraction. The next element of stroke volume is the emptying. 2021;25(1):146. Published 2021 Apr 16. link] Roland D.
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Updates in the Management of Refractory Ventricular Tachycardia or Ventricular Fibrillation Arrest
ACEP Now
JULY 7, 2023
17 While previous evidence for the use of ECMO in refractory VF arrest has come from observational studies, the ARREST trial in 2020 represented the first open-label randomized trial evaluating the use of ECMO in the management of patients presenting to the ED in refractory VF arrest. References Tsao CW, et al. Circulation. Circulation.
SAEM Clinical Images Series: Seeing Double
ALiEM
MARCH 22, 2024
The two main causes of internuclear ophthalmoplegia are demyelination of the medial longitudinal fasciculus (MLF) from multiple sclerosis (MS) and ischemic cranial nerve damage from stroke. Usually, MS is seen in younger patients where both eyes are affected whereas strokes occur more often in older patients and only one eye is affected.
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ACTT-1 | CODA RCT | Steroids Sore Throat | Podcast Learning RCT | Neurons or Nephrons
JournalFeed
NOVEMBER 21, 2020
It’s the JournalFeed Podcast for the week of Nov 16-20, 2020. We cover ACTT-1 - remdesivir for COVID-19, CODA RCT - antibiotics or surgery for appendicitis, steroids for sore throat, how to learn more from podcasts, and whether creatinine screening makes a difference before imaging stroke patients.
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SGEM#354: Everybody Walk the Dinosaur and Not Take the MSU
The Skeptics' Guide to EM
JANUARY 1, 2022
Prospective, multicenter, controlled trial of mobile stroke units. Date: December 21st, 2021 Guest Skeptic: Dr. Prospective, multicenter, controlled trial of mobile stroke units. Background: No one who has listened to the SGEM will be surprised we are covering another paper looking at stroke. Reference: Grotta JC et al.
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Non-Invasive Blood Pressure Monitoring in Critically Ill Adults?
RebelEM
FEBRUARY 8, 2024
J Crit Care 2020. to 1.12; p = 0.03 for every change in 5ug/min Lower MAP Value: aOR 0.98; 95% CI 0.98 to 0.99; p <0.01 for every change in 1mmHg Higher BMI: aOR 1.04; 95% CI 1.01 to 1.09; p = 0.01 for an increase in 1 Increased Patient Age: aOR 1.31; 95% CI 1.30 to 1.37; p <0.01 to 2.47; p – 0.04 were they in the resuscitative phase?
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SGEM#292: With or Without You – Endovascular Treatment with or without tPA for Large Vessel Occlusions
The Skeptics' Guide to EM
MAY 23, 2020
Date: May 19th, 2020 Reference: Yang P et al. Endovascular thrombectomy with or without intravenous alteplase in acute stroke. Date: May 19th, 2020 Reference: Yang P et al. Endovascular thrombectomy with or without intravenous alteplase in acute stroke. Joseph’s Regional Medical Center in Paterson, NJ.
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SAEM Clinical Images Series: Retrobulbar Spot Sign
ALiEM
JANUARY 29, 2024
It requires immediate consultation with ophthalmology as well as neurology as it is considered a stroke equivalent. Stroke workup for CRAO is necessary, and don’t forget about secondary prevention/risk stratification which must be part of the management. 39,1 (2020): 197-202. 2015;46:2322–2324 [link] Smith, Austin T et al.
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SGEM#283: Can You Be Absolutely Right in Diagnosing a SAH Using a Clinical Decision Instrument?
The Skeptics' Guide to EM
FEBRUARY 8, 2020
Date: January 29th, 2020 Reference: Perry et al. Stroke 2019 Guest Skeptic: Dr. Rory Spiegel is an EM/CC doctor who splits his time in the Emergency Department and Critical Care department. Date: January 29th, 2020 Reference: Perry et al. He also has this amazing #FOAMed blog called EM Nerd. Reference: Perry et al.
How important are old ECGs in Non-obvious cases of potential OMI?
Dr. Smith's ECG Blog
NOVEMBER 14, 2023
Here is that last post: A 90-something with acute stroke. For examples of this phenomenon — See My Comment in the February 14, 2018 — July 21, 2020 — and December 22, 2022 posts in Dr. Smith's ECG Blog ). She has no chest symptoms. What is the diagnosis? He stated he had never had this before.
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SGEM#310: I Heard A Rumour – ER Docs are Not Great at the HINTS Exam
The Skeptics' Guide to EM
DECEMBER 5, 2020
Date: November 30th, 2020 Reference: Ohle R et al. AEM 2020 Guest Skeptic: Dr. Mary McLean is an Assistant Program Director at St. Date: November 30th, 2020 Reference: Ohle R et al. AEM 2020 Guest Skeptic: Dr. Mary McLean is an Assistant Program Director at St. A Systematic Review and Meta-analysis. How hard can it be?”
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Acute dyspnea in an older woman, is it OMI?
Dr. Smith's ECG Blog
FEBRUARY 18, 2024
This could be easily overlooked since there is complete heart block, but recognizing the atrial arrhythmia may mean prescribing anticoagulation to prevent stroke. The November 10, 2020 post — for PTA. The October 17, 2020 post — for a 70-year old woman with " Artifactual VT ". In this case, it is atrial fibrillation.
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emDOCs Podcast – Episode 100: Acute Chest Syndrome Part 1
EMDocs
MAY 15, 2024
American Society of Hematology 2020 guidelines for sickle cell disease: transfusion support. Published 2020 Feb 12. Infectious: bacterial or viral pneumonia ( M. pneumoniae, C. Based on light absorption from blood flow at the sensor site (using HbA, not HbS) Underestimates alveolar hypoxemia. 2020;4(2):327-355. 2020;10(1):2470.
The Latest in Critical Care, 7/10/23 (Issue #8)
PulmCCM
JULY 10, 2023
Read in JAMA When to start anticoagulation after ischemic stroke from atrial fibrillation It’s been unclear when to start anticoagulation after an ischemic stroke presumed due to thromboembolism from atrial fibrillation. Aspirin is sometimes given during the waiting period. There were two intracranial hemorrhages in each group.
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SGEM#293: CRASH in the US, CRASH in the US, CRASH-2 in the USA
The Skeptics' Guide to EM
MAY 30, 2020
Date: May 29th, 2020 Reference: Erramouspe et al. AEM May 2020 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. Date: May 29th, 2020 Reference: Erramouspe et al. AEM May 2020 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia.
Seizure in a 30 something
Dr. Smith's ECG Blog
SEPTEMBER 2, 2024
That said — in a patient who develops TdP — the overall ECG appearance of this initial ECG is consistent with low K+ and/or low Mg++ ( See My Comment in the May 9, 2020 post — for more on the ECG diagnosis of hypokalemia and hypomagnesemia ). Figure-1: I labeled the initial ECG in today's case.
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emDOCs Podcast – Episode 101: Acute Chest Syndrome Part 2
EMDocs
MAY 28, 2024
American Society of Hematology 2020 guidelines for sickle cell disease: transfusion support. Published 2020 Feb 12. Infectious: bacterial or viral pneumonia ( M. pneumoniae, C. Based on light absorption from blood flow at the sensor site (using HbA, not HbS). Underestimates alveolar hypoxemia. 2020;4(2):327-355. 2020;10(1):2470.
ICU Physiology in 1000 Words: The Right Atrial Pressure Does Not Determine Cardiac Output – Part 2
PulmCCM
NOVEMBER 17, 2023
For any given hemodynamic state, measure or estimate the P ra and CO [or stroke volume, SV] simultaneously and repeatedly after each intervention. The ultrasound journal 2020, 12(1):1-12. The trick, I believe, lies in ‘operating point guided resuscitation’ [OPGR]. What does this mean? Am J Cardiol 1990, 66(4):493-496.
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Ya, it's not over, ICUs still overrun
ER Nurses
JUNE 15, 2020
Or that you may come back after d/c with a massive heart attack or stroke bc COVID makes— Cherie Antoinette (@sheriantoinette) June 14, 2020 COVID-19 is vicious. When they say “recovered” they don’t tell you that that means you may need a lung transplant. This is an ER Nurses blog but we know there's
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SGEM#301: You Can’t Stop GI Bleeds with TXA
The Skeptics' Guide to EM
SEPTEMBER 19, 2020
Date: September 16th, 2020 Guest Skeptics: Dr. Robert Goulden and Dr. Audrey Marcotte are Chief Residents from the Royal College of Emergency Medicine Program at McGill University. The Lancet 2020 This was an SGEM Journal Club episode recorded live at McGill University Grand Rounds.
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Chest pain and shock: Is there a right ventricular OMI on this ECG? And should he undergo trancutaneous pacing?
Dr. Smith's ECG Blog
MAY 30, 2023
IV fluids for more preload are indicated, but not too much, as the RV can be overloaded with fluid, cause the septum to bow into the LV, and then harm LV stroke volume and cardiac output, leading to worsening hypotension, worse RV perfusion, worse RV function, and more RV failure. The February 11, 2020 post ( LA-RA reversal ).
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SGEM Xtra: The REBEL vs. The SKEPTIC at SMACC 2019
The Skeptics' Guide to EM
APRIL 4, 2020
Date: April 4th, 2020 It has been just over a year since Dr. Salim Razaie (REBEL EM) and I stepped into the ring for a boxing matched theme debate in Sydney, Australia. Date: April 4th, 2020 It has been just over a year since Dr. Salim Razaie ( REBEL EM) and I stepped into the ring for a boxing matched theme debate in Sydney, Australia.
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Serratus Anterior Plane Blocks for Rib Fractures in the ED
Taming the SRU
NOVEMBER 3, 2023
Broad strokes In this prospective, non-randomized study published by Kring et al in January 2022 out of Maine Medical Center, researchers compared mean pain scores at rest and during incentive spirometry before, at 15 minutes after, and then 60 minutes after treatment with a serratus anterior plane block. Ultrasound Med. 41, 2695–2701 (2022).
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A fascinating electrophysiology case. What is this wide complex tachycardia, and how best to manage it?
Dr. Smith's ECG Blog
JANUARY 9, 2024
Slow VT below the detection rate of the ICD lead to worsening heart failure and low stroke volume. Lowering the back up rate (LRL) of the ICD/pacer allowed for an intrinsic rhythm with physiologic AV conduction and normal AV synchrony with resultant increase in stroke volume and cardiac outpt.
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Continuous prolonged generalized weakness, lightheadedness, and presyncope. What might you suspect from the ECG?
Dr. Smith's ECG Blog
OCTOBER 28, 2023
There is very little filling, and thus very poor stroke volume. 23/WCC — 2/21/2020 ). 23/WCC — 2/21/2020 ). 23/WCC — 2/21/2020 ). 23/WCC — 2/21/2020 ). It is only a slit. This is because of the large LV myocardial mass due to HOCM. The heart rate is too fast for this poor filling.
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Symptomatic Bradycardia: Considering the Differential Diagnosis
Northwestern EM Blog
JUNE 16, 2024
The most common symptoms include: Lightheadedness Syncope Chest pain Exercise intolerance Fatigue **Important note: The heart rate at which patients experience symptoms may vary based on their ability to increase stroke volume. Bradyarrhythmias in Acute Myocardial Infarction. Circulation , 45 (3), 703–722. link] Tisdale, J. Campbell, K.
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